Paget Disease (cont.)
IN THIS ARTICLE
When Should Someone Seek Medical Care for Paget's Disease?
People should seek medical care if they have increasing bone pain or deformities potentially related to Paget's disease. Also, people with weakness or a change in bowel or bladder function should seek immediate care to assess for involvement of the spine, leading to compression of the spinal cord and nerve roots.
Questions to Ask the Doctor About Paget's Disease
People with Paget's disease should ask the doctor if they would benefit from medication. Additionally, people with Paget's disease should be periodically seen by their physician throughout their lives due to the low risk of malignant transformation to sarcoma.
What Specialists Treat Paget's Disease?
Physicians diagnosing and treating Paget's disease include primary-care providers (including internists and family practitioners), rheumatologists, geriatricians, endocrinologists, and orthopedists. Radiologists and nuclear-medicine doctors can help to diagnose Paget’s disease. Spine surgeons may treat Paget’s disease when spinal surgery is needed (rarely).
How Do Specialists Diagnose Paget's Disease?
Laboratory studies include both blood and urine studies. Bone-specific alkaline phosphatase is a specific laboratory study that provides information on the rate of bone turnover, which is increased in people with Paget's disease. Other laboratory studies include assessment of calcium, phosphate, and parathyroid hormone levels. In many cases, these levels remain normal. Urine tests include procollagen type I N-terminal propeptide (PINP), serum C-telopeptide (CTx), urinary N-telopeptide (NTx), and urinary hydroxyproline, which measure bone degradation products secreted in the urine. These studies may be useful in both diagnosis and long-term monitoring of the disease process and response to medical treatment.
Imaging studies are often limited to plain radiographs (X-ray films). Early in the disease process, osteolysis, or softening and destruction of bone mass, is seen on X-ray films. Later in the course of the disease, there is increased bone mass, or sclerosis. Radiographs are also necessary if fracture is suspected. Radiographs should also be used to evaluate for possible malignant transformation.
Bone scans are useful in assessing the extent of disease throughout the entire body.
CT scan and magnetic resonance imaging (MRI) can be useful in the evaluation of patients with neurologic dysfunction or muscle weakness to assess for involvement of the spine and compression of the spinal cord or nerve roots. Rarely, a bone biopsy is required, especially if malignancy is suspected.
Medically Reviewed by a Doctor on 10/27/2016
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